According to research published in Frontiers in Oncology, elevated platelet-to-lymphocyte ratio (PLR) and plasma C-reactive protein (CRP) level appear to predict poor prognosis independent of the Revised International Prognostic Scoring System (IPSS-R) score and may provide a novel evaluation factor for patients with myelodysplastic syndrome (MDS).

Researchers at the Ningbo First Hospital, in Ningbo, China, evaluated the prognostic value of inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), PLR, and CRP, in patients who were newly diagnosed with MDS.

Between from 2009 and 2019, a total of 213 patients with MDS (58% male and 42% female) were enrolled in and completed the study. Patients had a median age of 62 years (range, 16-90). The median overall survival (OS) was 26 months (range, 0-125; 95% CI, 15.1-36.9). Approximately 12% of patients had conversion of MDS to acute myeloid leukemia (AML).

Continue Reading

The researchers found that patients with higher PLR (>22.14), NLR (>3.75), and

CRP (>5 mg/L) levels had significantly shorter median OS than those with lower levels (PLR, 9 vs 60 months; P =.002; NLR, 11 vs 27 months; P =.019; CRP, 19 vs 44 months; P <.0001).

Using univariate analysis, the team demonstrated that age (≥60 years; P <.0001), sex (male; P =.018), lower hemoglobin level (<10 g/dl; P =.006), higher bone marrow blast percentage (>5%; P <.0001), higher-risk IPSS-R cytogenetics (P =.016), higher IPSS-R score (P <.0001), and higher levels of PLR (P =.003), NLR (P =.023), and CRP (P <.0001) were significantly associated with shorter OS.

They also found that patients with higher CRP levels had shorter leukemia-free survival (LFS; P =.041) but that higher PLR and NLR were not significantly associated with LFS (P >.05 for both).

Using a multivariate Cox proportional-hazards regression analysis, the researchers demonstrated that older age (P =.001), sex (male; P =.043), lower PLT (P =.046), higher BM blast percentage (P <.0001), higher-risk IPSS-R cytogenetics (P =.026), and higher levels of PLR (P =.031) and CRP (P =.029) remained associated with significantly worse OS.

“[T]he results of this study suggested that PLR and CRP were independent prognostic indicators for OS in MDS,” the researchers wrote in their report. “Considering the cost-effectiveness and feasibility, these markers will be applicable for a large number of patients with MDS in the near future and further be integrated into customized treatment decision-making for MDS patients.”

Limitations of the study included the retrospective design, a relatively small sample size, limited information on patients’ comorbidities, lack of measurement of other inflammatory indicators, and limited information in the cohort for gene mutations linked to MDS prognosis.


Shi C, Gong S, Niu T, et al. The prognostic value of pretherapy peripheral blood inflammatory indices in myelodysplastic syndromes. Front Oncol. Published online April 26, 2022. doi:10.3389/fonc.2022.877981